Member Responds to Legislature's Failure to Pass H. 1996

Do you know what Congress has not done? I am very frustrated and disappointed that the “An Act to Remove Restrictions on the Licenses of Nurse Practitioners and CRNAs as Recommended by the Institute of Medicine and the Federal Trade Commission (H.B.1996/S.B.1207)” did not pass. Let me explain if this had happened, it would have translated into cost savings and better healthcare. The market place has grown considerably since the passing of Affordable Care Act which has offer health care to millions of under or uninsured Americans. According to the American Academy of Family Physicians, in 2016 the Primary Care Physicians are decreasing by 30%, and only 14% of medical students are graduating into Primary Care practice; thus producing a primary care provider shortage. Nurse Practitioners are thought to be the solution to the primary care provider shortage, however are prohibited because of current legislation.

Patient care has been affected, both in efficiency and quality. According to the Massachusetts Coalition of Nurse Practitioners, in 2016 patients are searching for Primary Care Providers, and in the western parts of Massachusetts cannot be seen upwards to 7 months, thus the accessibility as been limited, because of the overwhelming need for primary care providers and the lack of providers. The patients are lacking care, and the nurse practitioners are limited to their care because of the current legislation.

The quality of care of Nurse Practitioners is comparable if not better than to that of physicians. The Nurse Practitioners have a proven record of positive outcomes in primary care even though limited amount of education compare to physicians. The thirty-two states that do not have supervision have as positive outcomes as those with supervision. Even with the requirement of collaboration, there is no mandate or clinical requirement for a physician to be present. Research has demonstrated that in states with full practice of Nurse Practitioners have lower hospitalization rates. Therefore, Nurse Practitioners are as safe if not better outcomes without supervision. However, Massachusetts still does not change current legislation.

This has affected more than the Nurse Practitioner and patients. I am a healthcare primary care provider, Nurse Practitioner, working solo practice in rural Massachusetts for the last 7 years. I am struggling; my practice is making less money. There are so many restrictions that take money away from me. Nurse Practitioners are paid 20% less for the same services as doctors, and cannot participate in Medicare Shared Savings Program because of the language “physician” instead of “provider”. Massachusetts State law requires collaboration with a physician, in most cases have to pay upwards to $1000 for this collaboration for retrospective and vague collaboration. However, Nurse Practitioners will collaborate with the other specialists for the care of their patients and no payment is expected. Additionally, I, like other Nurse Practitioners, need to find her collaborated physician whom is off site, so he can admit patients in skilled nursing facilities, prescribe outpatient visiting nursing orders and diabetic shoes. There are huge delays in treatment and the patient suffers. When this happens the patient usually goes elsewhere for care and loses business and income.

Nurse Practitioners have conducted our business with due diligence, and met the burden of proof that Nurse Practitioners are safe, responsible, and affordable. Major organizations, such as Federal Trade Commission, Institute of Medicine, and National Institute for Health Care Reform, have endorsed Nurse Practitioners. They have recommended that Nurse Practitioners work to the fullest scope-of- practice, additionally promoting a national governance of licensure instead of various state-to-state legislative regulations. The language and statutes need to be change. In amidst of budget crisis and primary care provider shortage, there are antiqued laws that restrict nurse practitioner practice costing millions of dollars. Consult with us, the 205,000 Nurse Practitioners, the American Academy of Nurse Practitioners, the American Nurse Association, and Massachusetts Coalition of Nurse Practitioners, want a conversation to talk about removing the barriers of practice. Please resurrect “An Act to Remove Restrictions on the Licenses of Nurse Practitioners and CRNAs as Recommended by the Institute of Medicine and the Federal Trade Commission (H.B.1996/S.B.1207)”.